The role of the state has been underplayed in scholarship on global health. Taking a historical view, this paper argues that state institutions, practices and ideologies have in fact been crucial to the realisation of contemporary global health governance and to its predecessor regimes. Drawing on state theory, work on governmentality, and Third World approaches to international law, it traces the origins of the ‘health state’ in late colonial developmentalism, which held out the prospect of conditional independence for the subjects of European empires. Progress in health was also a key goal for nationalist governments in the Global South, one which they sought to realise autonomously as part of a New International Economic Order. The defeat of that challenge to the dominance of the Global North in the 1980s led to the rise of ‘global governance’ in health. Far from rendering the state redundant, the latter was realised through the co-option and disciplining of institutions at national level. To that extent, the current order has an unmistakably imperial character, one which undercuts its declared cosmopolitan aspirations, as evidenced in the approach to vaccine distribution and travel bans during the Covid-19 pandemic.

在全球健康学术领域，国家的作用一直被低估。从历史的角度来看，本文认为，国家制度、实践和意识形态实际上对于当代全球卫生治理及其前身政权的实现至关重要。它借鉴国家理论、政府治理研究和第三世界国际法方法，追溯了晚期殖民发展主义中“健康国家”的起源，为欧洲帝国的臣民提供了有条件独立的前景。健康方面的进步也是南方国家民族主义政府的一个关键目标，他们寻求将这一目标作为新国际经济秩序的一部分自主实现。20 世纪 80 年代，对全球北方主导地位的挑战失败，导致卫生领域“全球治理”的兴起。后者远没有使国家变得多余，而是通过国家层面机构的增选和约束来实现。从这个意义上说，当前的秩序无疑具有帝国主义特征，这削弱了其所宣称的国际化愿望，正如 Covid-19 大流行期间疫苗分发和旅行禁令的做法所证明的那样。